Are the current thresholds, indicators, and time window for cold warning effective enough to protect cardiovascular health?
Are the current thresholds, indicators, and time window for cold warning effective enough to protect cardiovascular health?
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DOI：
10.1016/j.scitotenv.2018.05.140
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发表时间：
2018-10-15
期刊：
影响因子：
--
通讯作者：
Stuart N
中科院分区：
文献类型：
--
作者：
Lin S;Lawrence WR;Lin Z;DiRienzo S;Lipton K;Dong GH;Leung R;Lauper U;Nasca P;Stuart N
更极端的寒冷天气和更大的天气变化引起了人们对其对公共健康影响的担忧。尽管先前的研究评估了冷空气温度对健康（尤其是死亡率）的影响，但有限的研究评估了风寒温度对发病率的影响以及当前寒冷警告阈值下的健康影响。这项研究通过比较冬季和冬季过渡月份风寒温度和冷空气温度对 CVD 急诊科 (ED) 就诊的影响，确定了极冷对心血管疾病 (CVD) 的阈值、滞后期和最佳指标。从纽约州全州医院出院数据集中收集了 662,625 例 CVD 急诊就诊的信息。气象因素，包括气温、风速和气压是从国家海洋和大气管理局收集的。在控制 PM2.5 后，采用病例交叉方法评估冬季（12 月至 2 月）和过渡月份（11 月和 3 月）的极冷与 CVD 关系。采用条件逻辑回归模型分析寒冷天气因素与 CVD 急诊就诊之间的关联。我们观察到，当风寒温度高达−3.8°C (25°F)，高于当前风寒警告标准（≤−28.8°C 或≤−20°F）时，就会发生CVD效应。风寒温度是冬季 CVD 急诊就诊的更敏感指标，温度≤−3.8°C (25°F)，具有延迟效应（滞后 6）；然而，过渡月份的气温较好，早期滞后天的气温≤7.2°C (45°F) (1-3)。在所有 CVD 亚型中，高血压急诊就诊与风寒温度和气温的负相关性最强。鉴于较大比例的 CVD 病例发生在比当前标准高得多的温度下，本研究建议修改当前的寒冷警告温度阈值。我们还建议在冬季过渡月份发布寒冷警报。
More extreme cold weather and larger weather variations have raised concerns regarding their effects on public health. Although prior studies assessed the effects of cold air temperature on health, especially mortality, limited studies evaluated wind chill temperatures on morbidity, and health effects under the current cold warning threshold. This study identified the thresholds, lag periods, and best indicators of extreme cold on cardiovascular disease (CVD) by comparing effects of wind chill temperatures and cold air temperatures on CVD emergency department (ED) visits in winter and winter transition months. Information was collected on 662,625 CVD ED visits from statewide hospital discharge dataset in New York State. Meteorological factors, including air temperature, wind speed, and barometric pressure were collected from National Oceanic and Atmospheric Administration. A case-crossover approach was used to assess the extreme cold-CVD relationship in winter (December-February) and transition months (November and March) after controlling for PM2.5. Conditional logistic regression models were employed to analyze the association between cold weather factors and CVD ED visits. We observed CVD effects occurred when wind chill temperatures were as high as −3.8°C (25°F), warmer than current wind chill warning standard (≤−28.8°C or ≤−20°F). Wind chill temperature was a more sensitive indicator of CVD ED visits during winter with temperatures ≤−3.8°C (25°F) with delay effect (lag 6); however, air temperature was better during transition months for temperatures ≤7.2°C (45°F) at earlier lag days (1–3). Among all CVD subtypes, hypertension ED visit had the strongest negative association with both wind chill temperature and air temperature. This study recommends modifying the current cold warning temperature threshold given larger proportions of CVD cases are occurring at considerably higher temperatures than the current criteria. We also recommend issuing cold warnings in winter transitional months.
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